Provider First Line Business Practice Location Address:
940 W SAN MARCOS BLVD
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92078-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-744-1881
Provider Business Practice Location Address Fax Number:
760-744-2103
Provider Enumeration Date:
09/16/2006